Incidence and risk factors of retinopathy of prematurity in extremely low birth weight babies in a tertiary neonatal care unit in northern India

To study the incidence and risk factors of Retinopathy of prematurity in extremely low birth weight babies in a tertiary neonatal care unit in northern India. A prospective cohort study of all neonates born during January 1, 2015 to December 31, 2015, with birth weight less than 1000 grams. Demographic details, risk factors and incidence of ROP were studied. Sixty babies were enrolled for the study with mean birth weight of 892.983±112.933 (560 to 1000) grams and mean gestation age of 29.47±2.258 (25-35) weeks. The incidence of ROP in this cohort was 50% (30 infants), out of which 23% (7 infants) required treatment (laser photocoagulation). The statistical analysis of risk factors on univariate analysis revealed significant association for oxygen exposure, apnoea, surfactant use, anaemia, blood transfusion, intraventricular haemorrhage, sepsis and antibiotic use. On multivariate logistic regression analysis anemia and oxygen exposure > week were found to be independent risk factors for development of ROP. The incidence of ROP was although high in this exclusive cohort of babies born <1000g but there is substantial decrease in incidence as compared to that reported in earlier studies. Gestational age <30 wks, being appropriate for gestation rather than small for gestation, anemia and oxygen exposure>1 week were found to be independent risk factors for development of ROP in this cohort.

The Survival Rate of Extremely Low Birth Weight Infants Improved in Guangdong Province, China

Background With the increase in extremely low birth weight (ELBW) infants, their outcomes received special attention. However, in China, studies of the outcomes of ELBW infants are rare. Methods The hospitalized records of ELBW infants discharged from twenty-six neonatal intensive care units were reviewed and analyzed. Results A total of 2575 ELBW infants were enrolled and the overall survival rate was 55.11%. From 2008 to 2017, the number of ELBW infants increased rapidly from 91 to 466, and the survival rate improved steadily from 41.76–62.02%. The survival rate rose with increasing BW, the ascending level of regional economic development and specialist hospitals. The incidence of complications was neonatal respiratory distress syndrome (85.2%), bronchopulmonary dysplasia (63.7%), retinopathy of prematurity (39.3%), intraventricular hemorrhage (29.4%), necrotizing enterocolitis (12.0%), and periventricular leukomalacia (8.0%). Among the 1156 nonsurvivors, 90.0% of infants died during the neonatal period (≤ 28 days), and the other died after the neonatal period. A total of 768 ELBW infants died after medical care withdrawal, with economic factors and expected outcome being important causes. Conclusion The number of ELBW infants is increasing in China, and the overall survival rate is still low but is improving steadily.

Clinical and Laboratory Findings of Nosocomial Sepsis in Extremely Low Birth Weight Infants According to Causative Organisms

Background: nosocomial sepsis remains a significant source of morbidity and mortality in extremely low birth weight (ELBW) infants. Early and accurate diagnosis is very important, but it is difficult due to the similarities in clinical manifestation between the causative microorganisms. We tried to identify the differences between causative microorganisms in clinical and laboratory findings and to help choose antibiotics, when sepsis was suspected in ELBW infants. Methods: a retrospective study was conducted on preterm infants, born at less than 28 weeks of gestation, with a birth weight of less than 1000 g between January 2009 and December 2019. Clinical and laboratory findings of suspected sepsis, after the first 72 h of life, were assessed. We classified them into four groups according to blood culture results (gram positive, gram negative, fungal, and negative culture groups) and compared them. Results: a total of 158 patients were included after using the exclusion criteria, with 45 (29%) in the gram positive group, 35 (22%) in the gram negative group, 27 (17%) in the fungal group, and 51 (32%) in the negative culture group. There were no significant differences in mean gestational age, birth weight, and neonatal morbidities, except for the age of onset, which was earlier in the fungal group than other groups. White blood cell (WBC) counts were the highest in the gram negative group and the lowest in the fungal group. The mean platelet counts were the lowest in the fungal group. C-reactive protein (CRP) levels were the highest in the gram negative group, while glucose was the highest in the fungal group. Conclusions: in conclusion, we showed that there are some differences in laboratory findings, according to causative microorganisms in the nosocomial sepsis of ELBW infants. Increased WBC and CRP were associated with gram negative infection, while decreased platelet and glucose level were associated with fungal infection. These data may be helpful for choosing empirical antibiotics when sepsis is suspected.

Staphylococcus lugdunensis Bacteremia with an Infected Aortic Thrombus in a Preterm Infant

Staphylococcus lugdunensis is a rare cause of late-onset sepsis in preterm infants. To our best knowledge, we report the fourth case of a male preterm infant who developed fulminant late-onset sepsis due to Staphylococcus lugdunensis with persistent bacteremia secondary to an infected aortic thrombus confirmed with two positive blood cultures. Our patient was an extremely low birth weight growth-restricted infant born at 27 weeks gestation and initially required an umbilical arterial catheter for blood pressure and blood gas monitoring. The course of this neonate was complicated by severe respiratory distress syndrome that evolved into chronic lung disease along with multiple episodes of tracheitis. Hemodynamically, the infant had a significant patent ductus arteriosus, and an episode of medical necrotizing enterocolitis followed by Staphylococcus lugdunensis septicemia. He was diagnosed with an infected aortic thrombus, probably the occult focus responsible for the persistent bacteremia. After a 6-week course of intravenous antibiotics and 4-week course of anticoagulant therapy, the infant responded and recovered without complications.

Growth during times of fear and emotional stress

Twenty-one scientists met for this year’s virtual conference on Auxology held at the University Potsdam, Germany, to discuss child and adolescent growth during times of fear and emotional stress. Growth within the broad range of normal for age and sex is considered a sign of good general health whereas fear and emotional stress can lead to growth faltering. Stunting is a sign of social disadvantage and poor parental education. Adverse childhood experiences affect child development, particularly in families with low parental education and low socioeconomic status. Negative effects were also shown in Indian children exposed prenatally and in early postnatal life to the cyclone Aila in 2009. Distrust, fears and fake news regarding the current Corona pandemic received particular attention though the effects generally appeared weak. Mean birth weight was higher; rates of low, very and extremely low birth weight were lower. Other topics discussed by the participants, were the influences of economic crises on birth weight, the measurement of self-confidence and its impact on growth, the associations between obesity, peer relationship, and behavior among Turkish adolescents, height trends in Indonesia, physiological neonatal weight loss, methods for assessing biological maturation in sportsmen, and a new method for skeletal age determination. The participants also discussed the association between acute myocardial infarction and somatotype in Estonia, rural-urban growth differences in Mongolian children, socio-environmental conditions and sexual dimorphism, biological mortality bias, and new statistical techniques for describing inhomogeneity in the association of bivariate variables, and for detecting and visualizing extensive interactions among variables.

Extended Interval Aminoglycoside Treatment for Klebsiella Pneumoniae Endocarditis in an Extremely Low Birth Weight Neonate

Infective endocarditis (IE) in neonates is associated with high mortality and incidence has been increasing over the past two decades. The majority of very low birth weight infants will be treated with at least one nephrotoxic medication during their hospital course. Over one-quarter of very low birth weight neonates exposed to gentamicin may develop acute kidney injury (AKI); this is particularly worrisome as AKI is an independent factor associated with increased neonatal mortality and increased length of stay. AKI during periods of neonatal nephrogenesis, which continues until 34–36 weeks postmenstrual age, may also have serious effects on the long-term nephron development which subsequently puts infants at risk of chronic kidney disease. Extended interval (EI) aminoglycoside (AMG) dosing has been used for decades in adult populations and has proven to reduce AKI while being at least as effective as traditional dosing, although there is limited published research for using an EI AMG in endocarditis in adults or pediatric patients. We describe an extremely low birth weight neonate, born preterm at 24 weeks gestation treated for Klebsiella pneumoniae IE that required AMG therapy who also had concurrent AKI. We utilized EI AMG combination therapy for treatment of Klebsiella pneumoniae endocarditis with good outcome and encourage others to report their experiences to improve our knowledge of EI AMG in this population.

Double Jeopardy: Prematurity and Congenital Heart Disease—What's Known and Why It's Important

This article is based on a composite of talks presented during the Double Jeopardy: Prematurity and Congenital Heart Disease Plenary Session at NeoHeart 2020, a global virtual conference. Prematurity and low weight remain significant risk factors for mortality after neonatal cardiac surgery despite a steady increase in survival. Newer and lower weight thresholds for operability are constantly generated as surgeons gather proficiency, technical mastery, and experience in performing complex procedures on extremely small infants. The relationship between birth weight and survival after cardiac surgery is nonlinear with 2 kilograms (kg) being an inflection point below which marked decline in survival occurs. The prevalence of congenital heart disease (CHD) in premature infants is more than twice that in term born infants. Increased risk of preterm birth in infants with CHD is most commonly due to spontaneous preterm birth and remains poorly understood. Advances in Neonatal-Perinatal medicine have led to a marked improvement in survival of neonates born prematurely over the last several decades. However, the risk of severe morbidities including retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia and necrotizing enterocolitis remains significant in extremely low birth weight infants. Premature infants with CHD are at a greater risk of prematurity related morbidities than premature infants without CHD. Interventions that have been successful in decreasing the risk of these morbidities are addressed.

Anatomical tracheal parameters in premature neonates with birth body weight less than 1000 g for effective and safe administration of surfactant

Objective. To evaluate anatomical tracheal parameters of fetus and premature infant for clarifying the permissible and safe depth of insertion and «thin catheter» diameter during minimally invasive administration of surfactant.Material and methods. Autopsy examination of fetuses and newborns with extremely low birth weight, who died during their first 168 hours of life. The study describes only 26 cases, respiratory system malformations are excluded. The authors measured the distance from the glottis to the bifurcation, the perimeter of the trachea under the ligaments, in the middle part and at the level of the bifurcation with the calculation of the trachea diameter.Results. The average body weight was 684.6 ± 160.8 g, gestational age varied from 21 to 33 weeks and averaged 25 weeks. The distance from the glottis to the bifurcation was 34.31 ± 5.28 mm, and the diameter in the upper, middle and lower thirds was 3.53 ± 0.64 mm, 3.41 ± 0.63 and 3.69 ± 0.78 mm respectivelyApplication of the results: registration of these indicators when choosing a catheter for minimally invasive administration of a surfactant and the depth of its introduction into the trachea in newborns with extremely low body weight will help to avoid such complications, as one-lung administration of surfactant and its regurgitation from the trachea during the procedure, thereby increasing the efficiency and safety of the methodConclusion. The length and diameter of trachea in neonates with extremely low birth weight in the early neonatal period depend on anthropometric values and gestational age at birth, mean length is 34.31±5.28 mm.